Search results for: Patrick Kee Peng Kong

Authors: Libing Zhu, Waichung Chen, Kwaicing Lo, Lei Li

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Background: Tian Jiu Therapy (a medicinal vesiculation therapy according to traditional Chinese medicine theory) in San Fu Days (the three hottest days in a year is calculated by the Chinese ancient calendar) is widely used by patients with chronic asthma in China although from modern medicine perspective there is insufficient evidence of its effectiveness and safety issues. We investigated the efficacy and safety of Tian Jiu Therapy compared with placebo in patients with chronic asthma. Methods: Patients with chronic asthma were randomly assigned to Tian Jiu treatment group (n=165), placebo control group (n=158). Registered Chinese Medicine practitioners, in Orthopedics-Traumatology, Acupuncture, and Tui-na Clinical Centre for Teaching and Research, School of Chinese Medicine, The University of Hong Kong, administered Tian Jiu Therapy and placebo treatment in 3 times over 2 months. Patients completed questionnaires and lung function test before treatment and after treatment, 3, 6, 9, and 11 months, respectively. The primary outcome was the no of asthma-related sub-healthy symptoms and the percentage of patients with twenty-three symptoms. Results: 451 patients were recruited totally, 111 patients refused or did not participate according the appointment time and 17 did not meet the inclusion criteria. Consequently, 323 of eligible patients were enrolled. There was nothing difference between Tian Jiu Therapy group and placebo control group at the end of all treatments neither primary nor secondary outcomes. While Tian Jiu Therapy as compared with placebo significantly reduced the percentage of participants who are susceptible waken up by asthma symptoms from 27% to 14% at 2nd follow-up (P < 0.05). Similarly, Tian Jiu Therapy significantly reduced the proportion of participants who had the symptom of running nose and sneezing before onset from 18% to 8% at 2nd follow-up (P < 0.05). Additionally, Tian Jiu Therapy significantly reduced the level of asthma, the proportion of participants who don’t need to processed during asthma attack increased from 6% to 15% at 1st follow-up and 0% to 7% at 3rd follow-up (P < 0.05). Improvements also occurred with Tian Jiu Therapy group, it reduced the proportion of participants who were spontaneously sweating at 3rd follow up and diarrhea after intake of oily food at 4th follow-up (P < 0.05). Conclusion: When added to a regimen of foundational therapy for chronic asthma participants, Tian Jiu Therapy further reduced the need for medications to control asthma, improved the quality of participants’ life, and significantly reduced the level of asthma. What is more, this benefit seems to have an accumulative effect over time was in accordance with the TCM theory of 'winter disease is being cured in summer'.

Keywords: asthma, Tian Jiu Therapy, San Fu Days, triaditional Chinese medicine, clinical trial

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Authors: Chan Yan Nok

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The present study is a qualitative study based on the coping experiences of six Hong Kong Chinese mothers who had childhood trauma from their first-person perspective. Expanding the perspective beyond the dominant discourse of “inter-generation transmission of trauma”, this study explores the experiences and meanings of child trauma embedded in their narratives through the process of thematic analysis and narrative analysis. The interviewees painted a nuanced picture of their process of coping and trauma resolution. First, acknowledgement; second, feel safe and start to tell the story of trauma; third, feel the feelings and expression of emotions; fourth, clarifying and coping with the impacts of trauma; fifth, integration and transformation; and sixth, using their new understanding of experience to have a better life. It was seen that there was no “end” within the process of trauma resolution. Instead, this is an ongoing process with positive healing trajectory. Analysis of the stories of the mothers revealed recurrent themes around continuous self-reflective awareness in the process of trauma coping. Rather than being necessarily negative and detrimental, childhood trauma could highlight the meanings of being a mother and reveal opportunities for continuous personal growth and self-enhancement. Utilizing the sense of inadequacy as a core driver in the trauma recovery process while developing a heightened awareness of the unfinished business embedded in their “automatic pattern” of behaviors, emotions, and thoughts can help these mothers become more flexible to formulate new methods in facing future predicaments. Future social work and parent education practices should help mothers deal with unresolved trauma, make sense of their impacts of childhood trauma and discover the growth embedded in the past traumatic experience. They should be facilitated in “acknowledging the reality of the trauma”, including understanding their complicated emotions arising from the traumatic experiences and voicing their struggles. In addition, helping these mothers to be aware of short-term and long-term trauma impacts (i.e., secondary responses to the trauma) and explore their effective coping strategies in “overcoming secondary responses to the trauma” are crucial for their future positive adjustment and transformation. Through affirming their coping abilities and lessons learnt from past experiences, mothers can reduce feelings of shame and powerlessness and enhance their parental capacity.

Keywords: childhood trauma, coping, mothers, self-awareness, self-reflection, trauma resolution

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Authors: W. L. Tsang, H. Y. Li, S. L. Wong, T. Y. Kwok, S. C. Yuen, S. S. Kwok, P. S. Ko, S. Y. Lau

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Introduction: Palliative care is no doubt necessary in surgery. When one looks at studies of what patients with life-threatening illness want and compares to what they experience in surgical units, the gap is huge. Surgical nurses, being patient advocates, should engage with patients and families sooner rather than later in their illness trajectories to consider how to manage the illness, not just their capacity to survive. Objective: This clinical practice guide aims to fill the service gap of palliative care in surgery by producing a quality-driven, evidence-based yet straightforward clinical practice guide based on a focus strategy. Methodology: In line with Guide to Good Nursing Practice: End-of-Life Care recommended by Nursing Council of Hong Kong and the strategic goal of improving quality of palliative care proposed in HA Strategic Plan 2017-2022, multiple phases of work were undertaken from July 2015 to December 2017. A pragmatic clinical practice guide for surgical patients facing life-threatening conditions was developed based on assessments on knowledge of and attitudes towards end-of-life care of surgical nurses. Key domains, including preparation for bereavement, nursing care for imminently dying patients and at the dying scene were crystallized according to the results of the assessments and the palliative care checklist formulated by UCH Palliative Care Team. After a year of rollout, its content was refined through analyses of implementation in routine practice and consensus opinions from frontline nurses. Results and Outcomes: This clinical practice guide inspires surgical nurses with the art of care to provide for patients’ comfort, function, and longevity. It provides practical directions and assists nurses to master the skills on advance care planning and learn how to be clear with patients, families and themselves about the realities of the disease pictures. Through the implementation, patients and families are included in the decision process, and their wishes are honored. The delivery of explicit and high-quality palliative care maintains good nurse-to-patient relations and enhances satisfaction of hospital care of patients and families. Conclusion: Surgical nursing has always been up to the unique challenges of the era. This clinical practice guide has become an island of credibility for our nurses as they traverse the often stormy waters of life-limiting illness.

Keywords: palliative care delivery, palliative care in surgery, hospice care, end-of-life care

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Authors: Hsueh Ping Peng

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End-stage renal disease most commonly occurs in the elderly population. Elderly people are approaching the end of their lives, and when facing major life-threatening situations, apart from aggressive medical treatment, they can also choose treatment methods such as hospice care to improve their quality of life. The purpose of this study was to investigate factors associated with the awareness and willingness to sign hospice and palliative care consent forms in elderly with end-stage renal disease. This study used both quantitative, cross-sectional study designs. In the quantitative section, 110 elderly patients (aged 65 or above) with end-stage renal disease receiving conventional hemodialysis were recruited as study participants from a medical center in Taipei City. Data were collected using structured questionnaires. Study tools included basic demographic data, questionnaires on the awareness and perception of hospice and palliative care, etc. After collecting the data, data analysis was conducted using SPSS 20.0 statistical software, including descriptive statistics, chi-square test, logistic regression, and other inferential statistics. The results showed that the average age of participants was 71.6 years old, more males than females, average years of dialysis was 6.1 years and most subjects rated their self-perceived health status as fair. Results of the study are summarized as follows: Elderly people with end-stage renal disease did not have sufficient knowledge and awareness about hospice and palliative care. Influencing factors included level of education, marital status, years of dialysis and age, etc. Demographic factors influencing the signing of consent forms included gender, marital status, and age, which all showed significant impacts. Factors taken into consideration when signing consent forms included awareness of hospice care, understanding the relevant definitions of hospice care, and understanding that consent may be modified or cancelled at any time; it was predicted that people who knew more about ways to receive hospice care or more related definitions were more willing to sign the consent forms. In the qualitative study section, 10 participants who signed the consent form, five male, and 5 female, between the ages of 65-90, have completed the semi-structured interviews. Analysis of the interviews revealed six themes: (1) passing away peacefully, (2) autonomy on arrangements of life and death, (3) unwillingness to increase family and social burden, (4) friends and relatives’ experience influencing the decision to give consent, (5) sharing information to facilitate the giving of consent, (6) facing each day with ease, to reflect the experience and factors of consideration for elderly with end-stage renal disease when signing consent forms. The results of this study provides the awareness, thoughts and feelings of elderly with end-stage renal disease on signing consent forms, and serve as a future reference for the dialysis unit to enhance the promotion of hospice and palliative care and related caregiving measures, thereby improving the quality of life and care for elderly people with end-stage renal disease.

Keywords: end-stage renal disease, hemodialysis, hospice and palliative care, awareness, willingness

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Authors: Adeel Zulifqar, Hong Hu

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Auxetic fabrics are a special kind of textile materials which possess negative Poisson’s ratio. Opposite to most of the conventional fabrics, auxetic fabrics get bigger in the transversal direction when stretched or get smaller when compressed. Auxetic fabrics are superior to conventional fabrics because of their counterintuitive properties, such as enhanced porosity under the extension, excellent formability to a curved surface and high energy absorption ability. Up till today, auxetic fabrics have been produced based on two approaches. The first approach involves using auxetic fibre or yarn and weaving technology to fabricate auxetic fabrics. The other method to fabricate the auxetic fabrics is by using non-auxetic yarns. This method has gained extraordinary curiosity of researcher in recent years. This method is based on realizing auxetic geometries into the fabric structure. In the woven fabric structure auxetic geometries can be realized by creating a differential shrinkage phenomenon into the fabric structural unit cell. This phenomenon can be created by using loose and tight weave combinations within the unit cell of interlacement pattern along with elastic and non-elastic yarns. Upon relaxation, the unit cell of interlacement pattern acquires a non-uniform shrinkage profile due to different shrinkage properties of loose and tight weaves in designed pattern, and the auxetic geometry is realized. The development of uni-stretch auxetic woven fabrics and bi-stretch auxetic woven fabrics by using this method has already been reported. This study reports the development of another kind of bi-stretch auxetic woven fabric. The fabric is first designed by transforming the auxetic geometry into interlacement pattern and then fabricated, using the available conventional weaving technology and non-auxetic elastic and non-elastic yarns. The tensile tests confirmed that the developed bi-stretch auxetic woven fabrics exhibit negative Poisson’s ratio over a wide range of tensile strain. Therefore, it can be concluded that the auxetic geometry can be realized into the woven fabric structure by creating the phenomenon of differential shrinkage and bi-stretch woven fabrics made of non-auxetic yarns having auxetic behavior and stretchability are possible can be obtained. Acknowledgement: This work was supported by the Research Grants Council of Hong Kong Special Administrative Region Government (grant number 15205514).

Keywords: auxetic, differential shrinkage, negative Poisson's ratio, weaving, stretchable

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Authors: Anna Höfer, Johannes Herrmann, Patrick Meybohm, Christopher Lotz

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Mitochondria are pivotal for energy supply and regulation of cellular functions. Deficiencies of mitochondrial metabolism have been implicated in diverse stressful conditions including infections. Platelets are key mediators for thrombo-inflammation during development and resolution of acute respiratory distress syndrome (ARDS). Previous data point to an exhausted platelet phenotype in critically-ill patients with coronavirus 19 disease (COVID-19) impacting the course of disease. The objective of this work was to characterize platelet mitochondrial metabolism in patients suffering from COVID-19 ARDSA longitudinal analysis of platelet mitochondrial metabolism in 24 patients with COVID-19 induced ARDS compared to 35 healthy controls (ctrl) was performed. Blood samples were analyzed at two time points (t1=day 1; t2=day 5-7 after study inclusion). The activity of mitochondrial citrate synthase was photometrically measured. The impact of oxidative stress on mitochondrial permeability was assessed by a photometric calcium-induced swelling assay and the activity of superoxide dismutase (SOD) by a SOD assay kit. The amount of protein carbonylation and the activity of mitochondria complexes I-IV were photometrically determined. Levels of interleukins (IL)-1α, IL-1β and tumor necrosis factor (TNF-) α were measured by a Multiplex assay kit. Median age was 54 years, 63 % were male and BMI was 29.8 kg/m2. SOFA (12; IQR: 10-15) and APACHE II (27; IQR: 24-30) indicated critical illness. Median Murray Score was 3.4 (IQR: 2.8-3.4), 21/24 (88%) required mechanical ventilation and V-V ECMO support in 14/24 (58%). Platelet counts in ARDS did not change during ICU stay (t1: 212 vs. t2: 209 x109/L). However, mean platelet volume (MPV) significantly increased (t1: 10.6 vs. t2: 11.9 fL; p<0.0001). Citrate synthase activity showed no significant differences between ctrl and ARDS patients. Calcium induced swelling was more pronounced in patients at t1 compared to t2 and to ctrl (50µM; t1: 0.006 vs. ctrl: 0.016 ΔOD; p=0.001). The amount of protein carbonylation as marker for irreversible proteomic modification constantly increased during ICU stay and compared to ctrl., without reaching significance. In parallel, superoxid dismutase activity gradually declined during ICU treatment vs. ctrl (t2: - 29 vs. ctrl.: - 17 %; p=0.0464). Complex I analysis revealed significantly stronger activity in ARDS vs. ctrl. (t1: 0.633 vs. ctrl.: 0.415 ΔOD; p=0.0086). There were no significant differences in complex II, III or IV activity in platelets from ARDS patients compared to ctrl. IL-18 constantly increased during the observation period without reaching significance. IL-1α and TNF-α did not differ from ctrl. However, IL-1β levels were significantly elevated in ARDS (t1: 16.8; t2: 16.6 vs. ctrl.: 12.4 pg/mL; p1=0.0335, p2=0.0032). This study reveals new insights in platelet mitochondrial metabolism during COVID-19 caused ARDS. it data point towards enhanced platelet activity with a pronounced turnover rate. We found increased activity of mitochondria complex I and evidence for enhanced oxidative stress. In parallel, protective mechanisms against oxidative stress were narrowed with elevated levels of IL-1β likely causing a pro-apoptotic environment. These mechanisms may contribute to platelet exhaustion in ARDS.

Keywords: acute respiratory distress syndrome (ARDS), coronavirus 19 disease (COVID-19), oxidative stress, platelet mitochondrial metabolism

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Authors: Patrick Louie Robles, Jerry Suls, Ciaran Friel, Mark Butler, Samantha Gordon, Frank Vicari, Joan Duer-Hefele, Karina W. Davidson

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Physical activity guidelines focus on increasing moderate-intensity activity for older adults, but adherence to recommendations remains low. This is despite the fact that scientific evidence finds increasing physical activity is positively associated with health benefits. Behavior change techniques (BCTs) have demonstrated some effectiveness in reducing sedentary behavior and promoting physical activity. This pilot study uses a personalized trials (N-of-1) design, delivered virtually, to evaluate the efficacy of using five BCTs in increasing low-intensity physical activity (by 2,000 steps of walking per day) in adults aged 45-75 years old. The 5 BCTs described in habit formation theory are goal setting, action planning, rehearsal, rehearsal in a consistent context, and self-monitoring. The study recruited health system employees in the target age range who had no mobility restrictions and expressed interest in increasing their daily activity by a minimum of 2,000 steps per day at least five days per week. Participants were sent a Fitbit Charge 4 fitness tracker with an established study account and password. Participants were recommended to wear the Fitbit device 24/7 but were required to wear it for a minimum of ten hours per day. Baseline physical activity was measured by Fitbit for two weeks. Participants then engaged remotely with a clinical research coordinator to establish a “walking plan” that included a time and day interval (e.g., between 7am -8am on Monday-Friday), a location for the walk (e.g., park), and how much time the plan would need to achieve a minimum of 2,000 steps over their baseline average step count (20 minutes). All elements of the walking plan were required to remain consistent throughout the study. In the 10-week intervention phase of the study, participants received all five BCTs in a single, time-sensitive text message. The text message was delivered 30 minutes prior to the established walk time and signaled participants to begin walking when the context (i.e., day of the week, time of day) they pre-selected is encountered. Participants were asked to log both the start and conclusion of their activity session by pressing a button on the Fitbit tracker. Within 30 minutes of the planned conclusion of the activity session, participants received a text message with a link to a secure survey. Here, they noted whether they engaged in the BCTs when prompted and completed an automaticity survey to identify how “automatic” their walking behavior had become. At the end of their trial, participants received a personalized summary of their step data over time, helping them learn more about their responses to the five BCTs. Whether the use of these 5 ‘habit formation’ BCTs in combination elicits a change in physical activity behavior among older adults will be reported. This study will inform the feasibility of a virtually-delivered N-of-1 study design to effectively promote physical activity as a component of healthy aging.

Keywords: aging, exercise, habit, walking

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Authors: Patrick Weber, Daniel Gredig

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Background and Purpose: Research has well documented the impact of discrimination and micro-aggressions on the wellbeing of gay men and, especially, adolescents. For the prevention of homophobic behavior against gay adolescents, however, the focus has to shift on those who discriminate: For the design and tailoring of prevention and intervention, it is important to understand the factors responsible for homophobic behavior such as, for example, verbal abuse. Against this background, the present study aimed to assess homophobic – in terms of verbally abusive – behavior against gay people among high school students. Furthermore, it aimed to establish the predictors of the reported behavior by testing an explanatory model. This model posits that homophobic behavior is determined by negative attitudes and knowledge. These variables are supposed to be predicted by the acceptance of traditional gender roles, religiosity, orientation toward social dominance, contact with gay men, and by the perceived expectations of parents, friends and teachers. These social-cognitive variables in turn are assumed to be determined by students’ gender, age, immigration background, formal school level, and the discussion of gay issues in class. Method: From August to October 2016, we visited 58 high school classes in 22 public schools in a county in Switzerland, and asked the 8th and 9th year students on three formal school levels to participate in survey about gender and gay issues. For data collection, we used an anonymous self-administered questionnaire filled in during class. Data were analyzed using descriptive statistics and structural equation modelling (Generalized Least Square Estimates method). The sample included 897 students, 334 in the 8th and 563 in the 9th year, aged 12–17, 51.2% being female, 48.8% male, 50.3% with immigration background. Results: A proportion of 85.4% participants reported having made homophobic statements in the 12 month before survey, 4.7% often and very often. Analysis showed that respondents’ homophobic behavior was predicted directly by negative attitudes (β=0.20), as well as by the acceptance of traditional gender roles (β=0.06), religiosity (β=–0.07), contact with gay people (β=0.10), expectations of parents (β=–0.14) and friends (β=–0.19), gender (β=–0.22) and having a South-East-European or Western- and Middle-Asian immigration background (β=0.09). These variables were predicted, in turn, by gender, age, immigration background, formal school level, and discussion of gay issues in class (GFI=0.995, AGFI=0.979, SRMR=0.0169, CMIN/df=1.199, p>0.213, adj. R2 =0.384). Conclusion: Findings evidence a high prevalence of homophobic behavior in the responding high school students. The tested explanatory model explained 38.4% of the assessed homophobic behavior. However, data did not found full support of the model. Knowledge did not turn out to be a predictor of behavior. Except for the perceived expectation of teachers and orientation toward social dominance, the social-cognitive variables were not fully mediated by attitudes. Equally, gender and immigration background predicted homophobic behavior directly. These findings demonstrate the importance of prevention and provide also leverage points for interventions against anti-gay bias in adolescents – also in social work settings as, for example, in school social work, open youth work or foster care.

Keywords: discrimination, high school students, gay men, predictors, Switzerland

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Authors: Mohamed Aljarallah, Mohamed Nurullah, George Saridakis

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This paper aims and objectives are to investigate how the structural change of the financial regulatory bodies affect the financial supervision and how the regulators can design such a structure with taking into account; the Central Bank, the conduct of business and the prudential regulators, it will also consider looking at the structure of the international regulatory bodies and what barriers are found. There will be five questions to be answered; should conduct of business and prudential regulation be separated? Should the financial supervision and financial stability be separated? Should the financial supervision be under the Central Bank? To what extent the politician should intervene in changing the regulatory and supervisory structure? What should be the regulatory and supervisory structure when there is financial conglomerate? Semi structure interview design will be applied. This research sample selection contains a collective of financial regulators and supervisors from the emerged and emerging countries. Moreover, financial regulators and supervisors must be at a senior level at their organisations. Additionally, senior financial regulators and supervisors would come from different authorities and from around the world. For instance, one of the participants comes from the International Bank Settlements, others come from European Central Bank, and an additional one will come from Hong Kong Monetary Authority and others. Such a variety aims to fulfil the aims and objectives of the research and cover the research questions. The analysis process starts with transcription of the interview, using Nvivo software for coding, applying thematic interview to generate the main themes. The major findings of the study are as follow. First, organisational structure changes quite frequently if the mandates are not clear. Second, measuring structural change is difficult, which makes the whole process unclear. Third, effective coordination and communication are what regulators looking for when they change the structure and that requires; openness, trust, and incentive. In addition to that, issues appear during the event of crisis tend to be the reason why the structure change. Also, the development of the market sometime causes a change in the regulatory structure. And, some structural change occurs simply because of the international trend, fashion, or other countries' experiences. Furthermore, when the top management change the structure tends to change. Moreover, the structure change due to the political change, or politicians try to show they are doing something. Finally, fear of being blamed can be a driver of structural change. In conclusion, this research aims to provide an insight from the senior regulators and supervisors from fifty different countries to have a clear understanding of why the regulatory structure keeps changing from time to time through a qualitative approach, namely, semi-structure interview.

Keywords: financial regulation bodies, financial regulatory structure, global financial regulation, financial crisis

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Authors: Sabrina Neururer, Marco Schweitzer, Werner Hackl, Bernhard Tilg, Patrick Raudaschl, Andreas Huber, Bernhard Pfeifer

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History and the current outbreak of Covid-19 have shown the deadly potential of infectious diseases. However, infectious diseases also have a serious impact on areas other than health and healthcare, such as the economy or social life. These areas are strongly codependent. Therefore, disease control measures, such as social distancing, quarantines, curfews, or lockdowns, have to be adopted in a very considerate manner. Infectious disease modeling can support policy and decision-makers with adequate information regarding the dynamics of the pandemic and therefore assist in planning and enforcing appropriate measures that will prevent the healthcare system from collapsing. In this work, an agent-based simulation package named “survival” for simulating infectious diseases is presented. A special focus is put on SARS-Cov-2. The presented simulation package was used in Austria to model the SARS-Cov-2 outbreak from the beginning of 2020. Agent-based modeling is a relatively recent modeling approach. Since our world is getting more and more complex, the complexity of the underlying systems is also increasing. The development of tools and frameworks and increasing computational power advance the application of agent-based models. For parametrizing the presented model, different data sources, such as known infections, wastewater virus load, blood donor antibodies, circulating virus variants and the used capacity for hospitalization, as well as the availability of medical materials like ventilators, were integrated with a database system and used. The simulation result of the model was used for predicting the dynamics and the possible outcomes and was used by the health authorities to decide on the measures to be taken in order to control the pandemic situation. The survival package was implemented in the programming language Java and the analytics were performed with R Studio. During the first run in March 2020, the simulation showed that without measures other than individual personal behavior and appropriate medication, the death toll would have been about 27 million people worldwide within the first year. The model predicted the hospitalization rates (standard and intensive care) for Tyrol and South Tyrol with an accuracy of about 1.5% average error. They were calculated to provide 10-days forecasts. The state government and the hospitals were provided with the 10-days models to support their decision-making. This ensured that standard care was maintained for as long as possible without restrictions. Furthermore, various measures were estimated and thereafter enforced. Among other things, communities were quarantined based on the calculations while, in accordance with the calculations, the curfews for the entire population were reduced. With this framework, which is used in the national crisis team of the Austrian province of Tyrol, a very accurate model could be created on the federal state level as well as on the district and municipal level, which was able to provide decision-makers with a solid information basis. This framework can be transferred to various infectious diseases and thus can be used as a basis for future monitoring.

Keywords: modelling, simulation, agent-based, SARS-Cov-2, COVID-19

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Authors: Linghua Kong, Xinxia Chen, Mika Gissler, Catharina Lavebratt

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Background: Prenatal exposure to preeclampsia has been associated with an increased risk of offspring attention-deficit/hyperactivity disorders (ADHD), autism spectrum disorder (ASD), and intellectual disability. However, little is known about the association between prenatal exposure to severe preeclampsia and neurodevelopmental and psychiatric disorders in offspring. Objective: This study aimed to assess the risk of maternal preeclampsia combined with perinatal problems, specifically low birth weight and prematurity, on offspring neuropsychiatric disorders. Methods: All singleton live births in Finland between 1996 and 2014 (n=1 012 723) were followed up in nation-wide registries until 2018. Main exposures included pre-eclampsia, small for gestational age, and delivery before 34 gestational weeks. Offspring neurodevelopmental and psychiatric disorders (ICD-10 codes) were examined as outcomes variables. Offspring birth year, sex, maternal age at delivery, parity, marital status at birth, mother's country of birth, maternal smoking, maternal gestational diabetes, maternal use of psychotropic medication during pregnancy, and maternal systemic inflammatory diseases were used as covariates. Risks for neurodevelopmental and psychiatric disorders were estimated using Cox proportional hazards modeling. Results: Of the 1 012 723 offspring, 25 901 (2.6%) were exposed to preeclampsia, and 93 281 (9.2%) were diagnosed with a neuropsychiatric disorder. Compared to births unexposed to preeclampsia, small for gestational age or delivery before 34 gestational weeks, those exposed to preeclampsia only had a 21% increase in the likelihood of any neuropsychiatric disorders after adjusting for potential confounding (adjusted HR=1.21, 95% CI: 1.15-1.26), while exposure to preeclampsia combined with small for gestational age or delivery before 34 gestational weeks had a more than twofold increased risk of having a child with neuropsychiatric disorders (adjusted HR=2.16, 95% CI: 2.02-2.32). The adjusted HR for neuropsychiatric disorders in offspring with small for gestational age or delivery before 34 gestational weeks only was 1.79 (95% CI: 1.73-1.83). In addition, the risk estimate in offspring exposed to both preeclampsia and perinatal problems was greater than those only exposed to preeclampsia for having personality disorders (adjusted HR=1.66; 95% CI: 1.07-2.57), intellectual disabilities (adjusted HR=3.47; 95% CI: 2.86-4.22), specific developmental disorders (adjusted HR=2.91; 95% CI: 2.69-3.15), ASD (adjusted HR=1.75; 95% CI: 1.42-2.17), ADHD and conduct disorders (adjusted HR=2.00; 95%CI: 1.76-2.27), and other behavioral and emotional disorders (adjusted HR=2.09; 95% CI: 1.84-2.37). Conclusion: In utero exposure to severe preeclampsia increased the risk of several neurodevelopmental and psychiatric disorders in offspring. Our findings are relevant to women with hypertensive disorders with regard to pregnancy consultation and management and may yield effective clues for the prevention of neurodevelopmental and psychiatric disorders in childhood.

Keywords: low birth weight, neurodevelopmental disorders, preeclampsia, prematurity, psychiatric disorders

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Authors: Patrick Cormier, Cesar Meylan, Matt Jensen, Dana Agar-Newman, Chloe Werle, Ming-Chang Tsai, Marc Klimstra

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Sprint-derived horizontal force-velocity-power (FVP) profiles can be developed with adequate validity and reliability with satellite (GPS/GNSS) systems. However, FVP metrics are sensitive to small nuances in data processing procedures such that minor differences in defining the onset and end of the sprint could result in different FVP metric outcomes. Furthermore, in team-sports, there is a requirement for rapid analysis and feedback of results from multiple athletes, therefore developing standardized and automated methods to improve the speed, efficiency and reliability of this process are warranted. Thus, the purpose of this study was to compare different methods of sprint end detection on the development of FVP profiles from 10Hz GPS/GNSS data through goodness-of-fit and intertrial reliability statistics. Seventeen national team female soccer players participated in the FVP protocol which consisted of 2x40m maximal sprints performed towards the end of a soccer specific warm-up in a training session (1020 hPa, wind = 0, temperature = 30°C) on an open grass field. Each player wore a 10Hz Catapult system unit (Vector S7, Catapult Innovations) inserted in a vest in a pouch between the scapulae. All data were analyzed following common procedures. Variables computed and assessed were the model parameters, estimated maximal sprint speed (MSS) and the acceleration constant τ, in addition to horizontal relative force (F₀), velocity at zero (V₀), and relative mechanical power (Pmax). The onset of the sprints was standardized with an acceleration threshold of 0.1 m/s². The sprint end detection methods were: 1. Time when peak velocity (MSS) was achieved (zero acceleration), 2. Time after peak velocity drops by -0.4 m/s, 3. Time after peak velocity drops by -0.6 m/s, and 4. When the integrated distance from the GPS/GNSS signal achieves 40-m. Goodness-of-fit of each sprint end detection method was determined using the residual sum of squares (RSS) to demonstrate the error of the FVP modeling with the sprint data from the GPS/GNSS system. Inter-trial reliability (from 2 trials) was assessed utilizing intraclass correlation coefficients (ICC). For goodness-of-fit results, the end detection technique that used the time when peak velocity was achieved (zero acceleration) had the lowest RSS values, followed by -0.4 and -0.6 velocity decay, and 40-m end had the highest RSS values. For intertrial reliability, the end of sprint detection techniques that were defined as the time at (method 1) or shortly after (method 2 and 3) when MSS was achieved had very large to near perfect ICC and the time at the 40 m integrated distance (method 4) had large to very large ICCs. Peak velocity was reached at 29.52 ± 4.02-m. Therefore, sport scientists should implement end of sprint detection either when peak velocity is determined or shortly after to improve goodness of fit to achieve reliable between trial FVP profile metrics. Although, more robust processing and modeling procedures should be developed in future research to improve sprint model fitting. This protocol was seamlessly integrated into the usual training which shows promise for sprint monitoring in the field with this technology.

Keywords: automated, biomechanics, team-sports, sprint

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Authors: Chor Yi Ng, Christine Kong, Loretta Teo, Stephen Yau, FC Cheung, TL Poon, Francis Lee

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Purpose: Dynamic conformal arc (DCA) and intensity modulated radiotherapy (IMRT) are two treatment techniques commonly used for stereotactic radiosurgery/radiotherapy of cranial lesions. IMRT plans usually give better dose conformity while DCA plans have better dose fall off. Rapid dose fall off is preferred for radiotherapy of cranial lesions, but dose conformity is also important. For certain lesions, DCA plans have good conformity, while for some lesions, the conformity is just unacceptable with DCA plans, and IMRT has to be used. The choice between the two may not be apparent until each plan is prepared and dose indices compared. We described a deviation index (DI) which is a measurement of the deviation of the target shape from a sphere, and test its functionality to choose between the two techniques. Method and Materials: From May 2015 to May 2017, our institute has performed stereotactic radiotherapy for 105 patients treating a total of 115 lesions (64 DCA plans and 51 IMRT plans). Patients were treated with the Varian Clinac iX with HDMLC. Brainlab Exactrac system was used for patient setup. Treatment planning was done with Brainlab iPlan RT Dose (Version 4.5.4). DCA plans were found to give better dose fall off in terms of R50% (R50% (DCA) = 4.75 Vs R50% (IMRT) = 5.242) while IMRT plans have better conformity in terms of treatment volume ratio (TVR) (TVR(DCA) = 1.273 Vs TVR(IMRT) = 1.222). Deviation Index (DI) is proposed to better facilitate the choice between the two techniques. DI is the ratio of the volume of a 1 mm shell of the PTV and the volume of a 1 mm shell of a sphere of identical volume. DI will be close to 1 for a near spherical PTV while a large DI will imply a more irregular PTV. To study the functionality of DI, 23 cases were chosen with PTV volume ranged from 1.149 cc to 29.83 cc, and DI ranged from 1.059 to 3.202. For each case, we did a nine field IMRT plan with one pass optimization and a five arc DCA plan. Then the TVR and R50% of each case were compared and correlated with the DI. Results: For the 23 cases, TVRs and R50% of the DCA and IMRT plans were examined. The conformity for IMRT plans are better than DCA plans, with majority of the TVR(DCA)/TVR(IMRT) ratios > 1, values ranging from 0.877 to1.538. While the dose fall off is better for DCA plans, with majority of the R50%(DCA)/ R50%(IMRT) ratios < 1. Their correlations with DI were also studied. A strong positive correlation was found between the ratio of TVRs and DI (correlation coefficient = 0.839), while the correlation between the ratio of R50%s and DI was insignificant (correlation coefficient = -0.190). Conclusion: The results suggest DI can be used as a guide for choosing the planning technique. For DI greater than a certain value, we can expect the conformity for DCA plans to become unacceptably great, and IMRT will be the technique of choice.

Keywords: cranial lesions, dynamic conformal arc, IMRT, image guided radiotherapy, stereotactic radiotherapy

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Authors: Jimmy K. C. Lam, Carrie Wong

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One of the key goals on Learning and Teaching as documented in the University strategic plan 2012/13 – 2017/18 is to encourage active learning, the use of innovative teaching approaches and technology, and promoting the adoption of flexible and varied teaching delivery methods. This research reported the recent visited to Prof Eric Mazur at Harvard University on Peer Instruction: Collaborative learning in large class and innovative use of technology to enable new mode of learning. Peer Instruction is a research-based, interactive teaching method developed by Prof. Eric Mazur at Harvard University in the 1990s. It has been adopted across the disciplines, institutional type and throughout the world. One problem with conventional teaching lies in the presentation of the material. Frequently, it comes straight out of textbook/notes, giving students little incentive to attend class. This traditional presentation is always delivered as monologue in front of passive audience. Only exceptional lecturers are capable of holding students’ attention for an entire lecture period. Consequently, lectures simply reinforce students’ feelings that the most important step in mastering the material is memorizing a zoo of unrelated examples. In order to address these misconceptions about learning, Prof Mazur’s Team developed “Peer Instruction”, a method which involves students in their own learning during lectures and focuses their attention on underling concepts. Lectures are interspersed with conceptual questions called Concept Tests, designed to expose common difficulties in understanding the material. The students are given one or two minutes to think about the question and formulate their own answers; they then spend two or three minutes discussing their answers in a group of three or four, attempting to reach consensus on the correct answer. This process forces the students to think through the arguments being developed, and enable them to assess their understanding concepts before they leave the classroom. The findings from Peer Instruction and innovative use of technology on teaching at Harvard University were applied to the first year Textiles and Fashion students in Hong Kong. Survey conducted from 100 students showed that over 80% students enjoyed the flexibility of peer instruction and 70% of them enjoyed the instant feedback from the Clicker system (Student Response System used at Harvard University). Further work will continue to explore the possibility of peer instruction to art and fashion students.

Keywords: peer instruction, education, technology, fashion

Procedia PDF Downloads 307

Authors: Yi Meng, Yun Gao

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Having spent significant periods studying and working in North America and Europe, we, as two Chinese art educators, have been profoundly shaped by both Eastern and Western cultures. Consequently, our ambition is to enrich students' learning experiences by delving into and merging both cultural perspectives for innovative, creative expressions. This exposition draws on our action research study on students' visual literacy practices in a visual literacy course at a prominent Chinese university. The central premise was to explore innovative art forms by cross-utilizing various aspects of diverse cultures. By examining distinct cultural elements, we encouraged students to break away from familiar approaches and forge new paths in their creative endeavors. In implementing our curriculum, we utilized a multimodal pedagogy that deviated from the predominant print-based presentations typically employed in our classroom settings. This pedagogical approach effectively encouraged students to critically analyze the artifact, imbue it with their understanding and perspectives, and then produce an original piece. This approach also motivated students to leverage the semiotic potential of various communicative modes to address diverse cultural issues through their multimodal designs. To demonstrate the potential for cultural amalgamation, we utilized the artwork of Hong Kong-based artist Tik Ka. His works epitomize the fusion of Chinese traditions with Western pop culture, which served as a visual and conceptual reference point for students. Seeing how these distinct cultural elements could coexist and enrich each other in Tik Ka's work was inspiring and motivating for the students. Taken together, these pedagogical strategies helped create a dialogical space where students could actively experience, analyze, and negotiate complex modes of expression. This environment fostered active learning, encouraging students to apply their knowledge, question their assumptions, and reconsider their perspectives. Overall, such a unique approach to visual literacy education has the potential to reshape students' understanding of both cultures. By encouraging them to critically engage with their multimodal designs, we promoted an in-depth, nuanced appreciation of these diverse cultural heritages. The students no longer just interpreted and replicated images—they actively contributed to a dynamic and ongoing conversation between cultures.

Keywords: multimodal pedagogy, creative expressions, visual literacy education, multimodal designs

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Authors: Jia-Ling Ho, Xiu-Ru Zhang, Zwe-Ling Kong

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Diabetes mellitus (DM) is a major health problem that affects patients’ life quality throughout the world due to its many complications. It characterized by chronic hyperglycemia with oxidative stress, which impaired male reproductive function. Fibroblast growth factor 21 (FGF21) is a metabolic regulator that is required for normal spermatogenesis and protects against diabetes-induced germ cell apoptosis. Echinacea purpurea ethanol extract (EE), which contain phenolic acid and isobutylamide, had been proven to have antidiabetic property. Silica-chitosan nanoparticles (Nano-CS) has drug delivery and controlled release properties. This study aims to investigate whether silica-chitosan nanoparticles encapsulated EE (Nano-EE) had more ameliorating male infertility by analyzing the effect of testicular FGF21. The Nano-EE was characterized before used to treatment the diabetic rat model. Male Sprague-Dawley (SD) rats were obtained and divided into seven groups. A group was no induced Streptozotocin (STZ), marked as normal group. Diabetic rats were induced into diabetes by STZ (33 mg/kg). A diabetic group was no treatment with sample (diabetic control group), and other groups were treatment by Nano-CS (465 mg/kg), Nano-EE (93, 279, 465 mg/kg), and metformin (Met) (200 mg/kg) used as reference drug for 7 weeks. Our results indicated that the average nanoparticle size and zeta potential of Nano-EE were 2630 nm and -21.3 mV, respectively. The encapsulation ratio of Nano-EE was about 70%. It also confirmed the antioxidative activity was unchanged by comparing the DPPH and ABTS scavenging of Nano-EE and EE. In vivo test, Nano-EE can improve the STZ induced hyperglycemia, insulin resistance, and plasma FGF21 levels. Nano-EE has increased sperm motility, mitochondria membrane potential (MMP), plasma testosterone level, and reduction of abnormal sperm, nitric oxide (NO), superoxide production as well as reactive oxygen species (ROS). In addition, in plasma antioxidant enzymes glutathione peroxidase (GPx) and superoxide dismutase (SOD) was increased whereas pro-inflammatory cytokines TNF-α, and IL-1β were decreased. Further, in testis, protein content of FGF21, PGC-1α, and SIRT1 were improved. Nano-EE might improve diabetes-induced down-regulation of testicular FGF21 and SIRT1/PGC-1α signaling hence maintain spermatogenesis.

Keywords: diabetes mellitus, Echinacea purpurea, reproductive dysfunction, silica-chitosan nanoparticles

Procedia PDF Downloads 176

Authors: Maria De Los Angeles Ortega, Denis Bruneau, Patrick Sebastian, Jean-Pierre Nadeau, Alain Sommier, Saed Raji

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Phase change materials (PCM) present attractive features that made them a passive solution for thermal comfort assessment in buildings during summer time. They show a large storage capacity per volume unit in comparison with other structural materials like bricks or concrete. If their use is matched with the peak load periods, they can contribute to the reduction of the primary energy consumption related to cooling applications. Despite these promising characteristics, they present some drawbacks. Commercial PCMs, as paraffines, offer a low thermal conductivity affecting the overall performance of the system. In some cases, the material can be enhanced, adding other elements that improve the conductivity, but in general, a design of the unit that optimizes the thermal performance is sought. The material selection is the departing point during the designing stage, and it does not leave plenty of room for optimization. The PCM melting point depends highly on the atmospheric characteristics of the building location. The selection must relay within the maximum, and the minimum temperature reached during the day. The geometry of the PCM container and the geometrical distribution of these containers are designing parameters, as well. They significantly affect the heat transfer, and therefore its phenomena must be studied exhaustively. During its lifetime, an air-PCM unit in a building must cool down the place during daytime, while the melting of the PCM occurs. At night, the PCM must be regenerated to be ready for next uses. When the system is not in service, a minimal amount of thermal exchanges is desired. The aforementioned functions result in the presence of sensible and latent heat storage and release. Hence different types of mechanisms drive the heat transfer phenomena. An experimental test was designed to study the heat transfer phenomena occurring in a circular tube bundle air-PCM exchanger. An in-line arrangement was selected as the geometrical distribution of the containers. With the aim of visual identification, the containers material and a section of the test bench were transparent. Some instruments were placed on the bench for measuring temperature and velocity. The PCM properties were also available through differential scanning calorimeter (DSC) tests. An evolution of the temperature during both cycles, melting and solidification were obtained. The results showed some phenomena at a local level (tubes) and on an overall level (exchanger). Conduction and convection appeared as the main heat transfer mechanisms. From these results, two approaches to analyze the heat transfer were followed. The first approach described the phenomena in a single tube as a series of thermal resistances, where a pure conduction controlled heat transfer was assumed in the PCM. For the second approach, the temperature measurements were used to find some significant dimensionless numbers and parameters as Stefan, Fourier and Rayleigh numbers, and the melting fraction. These approaches allowed us to identify the heat transfer phenomena during both cycles. The presence of natural convection during melting might have been stated from the influence of the Rayleigh number on the correlations obtained.

Keywords: phase change materials, air-PCM exchangers, convection, conduction

Procedia PDF Downloads 165

Authors: Yiu K. C. Jacky, Tang S. K. Eric, W. Y. Tsang, C. Y. Li, C. K. Leung

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Objectives : (1) To enhance the competence of nurses on using IPMOE for drug administration; (2) To ensure the transition on implementation of IPMOE in safer and smooth way hospital-wide. Methodology: (1) Well-structured Governance: To make provision for IPMOE implementation, multidisciplinary governance structure at Corporate and Local levels are well established. (2) Staff Engagement: A series of staff engagement events were conducted including Staff Forum, IPMOE Hospital Visit, Kick-off Ceremony and establishment of IPMOE Webpage for familiarizing the forthcoming implementation with frontline staff. (3) Well-organized training program: from Workshop to Workplace Two different IPMOE training programs were tailor-made which aimed at introducing the core features of administration module. Fifty-five identical training classes and six train-the-trainer workshops were organized at 2-3Q 2015. Lending Scheme on IPMOE hardware for hands-on practicing was launched and further extended the training from workshop to workplace. (4) Standard Guidelines and Workflow: the related workflow and guidelines are developed which facilitates users to acquire the competence towards IPMOE and fully familiarize with the standardized contingency plan. (5) Facilities and Equipment: The installations of IPMOE hardware were promptly arranged for rollout. Besides, IPMOE training venue was well-established for staff training. (6) Risk Management Strategy: UCH Medication Safety Forum is organized in December 2015 for sharing “Tricks & Tips” on IPMOE which further disseminate at webpage for arousal of medication safety. Hospital-wide annual audit on drug administration was planned to figure out the compliance and deliberate the rooms for improvement. Results: Through the comprehensive training plan, over 1,000 UCH nurses attended the training program with positive feedback. They agreed that their competence on using IPMOE was enhanced. By the end of November 2015, 28 wards (over 1,000 Inpatient-bed) involving departments of M&G, SUR, O&T and O&G have been successfully rolled out IPMOE in 5-month. A smooth and safe transition of implementation of IPMOE was achieved. Eventually, we all get prepared for embedding IPMOE into daily nursing and work altogether for medication safety at UCH.

Keywords: drug administration, inpatient medication order entry system, medication safety, nursing informatics

Procedia PDF Downloads 321

Authors: Bai-Chen Xie, Xian-Peng Chen

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China has become the world's largest energy producer and consumer, and its development of renewable energy is of great significance to global energy governance and the fight against climate change. The rapid growth of solar power in China could help achieve its ambitious carbon peak and carbon neutrality targets early. However, the non-technical costs of solar power in China are much higher than at international levels, meaning that inefficiencies are rooted in poor management and improper policy design and that efficiency distortions have become a serious challenge to the sustainable development of the renewable energy industry. Unlike fossil energy generation technologies, the output of solar power is closely related to the volatile solar resource, and the spatial unevenness of solar resource distribution leads to potential efficiency spatial distribution differences. It is necessary to develop an efficiency evaluation method that considers the volatility of solar resources and explores the mechanism of the influence of natural geography and social environment on the spatially varying characteristics of efficiency distribution to uncover the root causes of managing inefficiencies. The study sets solar resources as stochastic inputs, introduces a chance-constrained data envelopment analysis model combined with the directional distance function, and measures the solar resource utilization efficiency of 222 solar power plants in representative photovoltaic bases in northwestern China. By the meta-frontier analysis, we measured the characteristics of different power plant clusters and compared the differences among groups, discussed the mechanism of environmental factors influencing inefficiencies, and performed statistical tests through the system generalized method of moments. Rational localization of power plants is a systematic project that requires careful consideration of the full utilization of solar resources, low transmission costs, and power consumption guarantee. Suitable temperature, precipitation, and wind speed can improve the working performance of photovoltaic modules, reasonable terrain inclination can reduce land cost, and the proximity to cities strongly guarantees the consumption of electricity. The density of electricity demand and high-tech industries is more important than resource abundance because they trigger the clustering of power plants to result in a good demonstration and competitive effect. To ensure renewable energy consumption, increased support for rural grids and encouraging direct trading between generators and neighboring users will provide solutions. The study will provide proposals for improving the full life-cycle operational activities of solar power plants in China to reduce high non-technical costs and improve competitiveness against fossil energy sources.

Keywords: solar power plants, environmental factors, data envelopment analysis, efficiency evaluation

Procedia PDF Downloads 76

Authors: Ciaran Friel, Jerry Suls, Mark Butler, Patrick Robles, Samantha Gordon, Frank Vicari, Karina W. Davidson

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Physical activity guidelines focus on increasing moderate-intensity activity for older adults, but adherence to recommendations remains low. This is despite the fact that scientific evidence supports that any increase in physical activity is positively correlated with health benefits. Behavior change techniques (BCTs) have demonstrated effectiveness in reducing sedentary behavior and promoting physical activity. This pilot study uses a Personalized Trials (N-of-1) design to evaluate the efficacy of using four BCTs to promote an increase in low-intensity physical activity (2,000 steps of walking per day) in adults aged 45-75 years old. The 4 BCTs tested were goal setting, action planning, feedback, and self-monitoring. BCTs were tested in random order and delivered by text message prompts requiring participant engagement. The study recruited health system employees in the target age range, without mobility restrictions and demonstrating interest in increasing their daily activity by a minimum of 2,000 steps per day for a minimum of five days per week. Participants were sent a Fitbit® fitness tracker with an established study account and password. Participants were recommended to wear the Fitbit device 24/7 but were required to wear it for a minimum of ten hours per day. Baseline physical activity was measured by Fitbit for two weeks. In the 8-week intervention phase of the study, participants received each of the four BCTs, in random order, for a two-week period. Text message prompts were delivered daily each morning at a consistent time. All prompts required participant engagement to acknowledge receipt of the BCT message. Engagement is dependent upon the BCT message and may have included recording that a detailed plan for walking has been made or confirmed a daily step goal (action planning, goal setting). Additionally, participants may have been directed to a study dashboard to view their step counts or compare themselves to their baseline average step count (self-monitoring, feedback). At the end of each two-week testing interval, participants were asked to complete the Self-Efficacy for Walking Scale (SEW_Dur), a validated measure that assesses the participant’s confidence in walking incremental distances, and a survey measuring their satisfaction with the individual BCT that they tested. At the end of their trial, participants received a personalized summary of their step data in response to each individual BCT. The analysis will examine the novel individual-level heterogeneity of treatment effect made possible by N-of-1 design and pool results across participants to efficiently estimate the overall efficacy of the selected behavioral change techniques in increasing low-intensity walking by 2,000 steps, five days per week. Self-efficacy will be explored as the likely mechanism of action prompting behavior change. This study will inform the providers and demonstrate the feasibility of an N-of-1 study design to effectively promote physical activity as a component of healthy aging.

Keywords: aging, exercise, habit, walking

Procedia PDF Downloads 82

Authors: Carmen Axisa, Louise Nash, Patrick Kelly, Simon Willcock

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Introduction: Doctors experience high levels of burnout, stress and psychiatric morbidity. This can affect the health of the doctor and impact patient care. Study Aims: To evaluate the effectiveness of a workshop intervention to promote wellbeing for Australian Physician Trainees. Methods: A workshop was developed in consultation with specialist clinicians to promote health and wellbeing for physician trainees. The workshop objectives were to improve participant understanding about factors affecting their health and wellbeing, to outline strategies on how to improve health and wellbeing and to encourage participants to apply these strategies in their own lives. There was a focus on building resilience and developing long term healthy behaviours as part of the physician trainee daily lifestyle. Trainees had the opportunity to learn practical strategies for stress management, gain insight into their behaviour and take steps to improve their health and wellbeing. The workshop also identified resources and support systems available to trainees. The workshop duration was four and a half hours including a thirty- minute meal break where a catered meal was provided for the trainees. Workshop evaluations were conducted at the end of the workshop. Sixty-seven physician trainees from Adult Medicine and Paediatric training programs in Sydney Australia were randomised into intervention and control groups. The intervention group attended a workshop facilitated by specialist clinicians and the control group did not. Baseline and post intervention measurements were taken for both groups to evaluate the impact and effectiveness of the workshop. Forty-six participants completed all three measurements (69%). Demographic, personal and self-reported data regarding work/life patterns was collected. Outcome measures include Depression Anxiety Stress Scale (DASS), Professional Quality of Life Scale (ProQOL) and Alcohol Use Disorders Identification Test (AUDIT). Results: The workshop was well received by the physician trainees and workshop evaluations showed that the majority of trainees strongly agree or agree that the training was relevant to their needs (96%) and met their expectations (92%). All trainees strongly agree or agree that they would recommend the workshop to their medical colleagues. In comparison to the control group we observed a reduction in alcohol use, depression and burnout but an increase in stress, anxiety and secondary traumatic stress in the intervention group, at the primary endpoint measured at 6 months. However, none of these differences reached statistical significance (p > 0.05). Discussion: Although the study did not reach statistical significance, the workshop may be beneficial to physician trainees. Trainees had the opportunity to share ideas, gain insight into their own behaviour, learn practical strategies for stress management and discuss approach to work, life and self-care. The workshop discussions enabled trainees to share their experiences in a supported environment where they learned that other trainees experienced stress and burnout and they were not alone in needing to acquire successful coping mechanisms and stress management strategies. Conclusion: These findings suggest that physician trainees are a vulnerable group who may benefit from initiatives that promote wellbeing and from a more supportive work environment.

Keywords: doctors' health, physician burnout, physician resilience, wellbeing workshop

Procedia PDF Downloads 176

Authors: Huan Peng, Chenye Zeng, Zhao Wang

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Alzheimer’s disease (AD) is an age-related neurodegenerative disease that is a leading cause of dementia syndromes and has become a huge burden on society and families. The main pathological features of AD involve excessive deposition of β-amyloid (Aβ) and Tau proteins in the brain, resulting in loss of neurons, expansion of neuroinflammation, and cognitive dysfunction in patients. Researchers have found effective drugs to clear the brain of error-accumulating proteins or to slow the loss of neurons, but their direct administration has key bottlenecks such as single-drug limitation, rapid blood clearance rate, impenetrable blood-brain barrier (BBB), and poor ability to target tissues and cells. Therefore, we are committed to seeking a suitable and efficient delivery system. Inspired by the possibility that exosomes may be involved in the secretion and transport mechanism of many signaling molecules or proteins in the brain, exosomes have attracted extensive attention as natural nanoscale drug carriers. We selected exosomes derived from bone marrow mesenchymal stem cells (MSC-EXO) with low immunogenicity and exosomes derived from hippocampal neurons (HT22-EXO) that may have excellent homing ability to overcome the deficiencies of oral or injectable pathways and bypass the BBB through nasal administration and evaluated their delivery ability and effect on AD. First, MSC-EXO and HT22 cells were isolated and cultured, and MSCs were identified by microimaging and flow cytometry. Then MSC-EXO and HT22-EXO were obtained by gradient centrifugation and qEV SEC separation column, and a series of physicochemical characterization were performed by transmission electron microscope, western blot, nanoparticle tracking analysis and dynamic light scattering. Next, exosomes labeled with lipophilic fluorescent dye were administered to WT mice and APP/PS1 mice to obtain fluorescence images of various organs at different times. Finally, APP/PS1 mice were administered intranasally with two exosomes 20 times over 40 days and 20 μL each time. Behavioral analysis and pathological section analysis of the hippocampus were performed after the experiment. The results showed that MSC-EXO and HT22-EXO were successfully isolated and characterized, and they had good biocompatibility. MSC-EXO showed excellent brain enrichment in APP/PS1 mice after intranasal administration, could improve the neuronal damage and reduce inflammation levels in the hippocampus of APP/PS1 mice, and the improvement effect was significantly better than HT22-EXO. However, intranasal administration of the two exosomes did not cause depression and anxious-like phenotypes in APP/PS1 mice, nor significantly improved the short-term or spatial learning and memory ability of APP/PS1 mice, and had no significant effect on the content of Aβ plaques in the hippocampus, which also meant that MSC-EXO could use their own advantages in combination with other drugs to clear Aβ plaques. The possibility of realizing highly effective non-invasive synergistic treatment for AD provides new strategies and ideas for clinical research.

Keywords: Alzheimer’s disease, exosomes derived from mesenchymal stem cell, intranasal administration, therapy-carrier dual roles

Procedia PDF Downloads 41

Authors: Tas Yong Koh, Steve Rowlinson, Yuzhong Shen

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In construction safety management, safety climate has long been linked to workers' safety behaviors and performance. For this reason, safety climate concept and tools have been used as heuristics to diagnose a range of safety-related issues by some progressive contractors in Hong Kong and elsewhere. However, as a diagnostic tool, safety climate tends to treat the different components of the climate construct in a linear fashion. Safety management in construction projects, in reality, is a multi-faceted and multilevel phenomenon that resembles a complex system. Hence, understanding safety management in construction projects requires not only the understanding of safety climate but also the organizational-systemic nature of the phenomenon. Our involvement, diagnoses, and interpretations of a range of safety climate-related issues which culminated in the project’s sub-optimum safety performance in an infrastructure construction project have brought about such revelation. In this study, a range of data types had been collected from various hierarchies of the project site organization. These include the frontline workers and supervisors from the main and sub-contractors, and the client supervisory personnel. Data collection was performed through the administration of safety climate questionnaire, interviews, observation, and document study. The findings collectively indicate that what had emerged in parallel of the seemingly linear climate-based exploration is the exposition of the organization-systemic nature of the phenomenon. The results indicate the negative impacts of climate perceptions mismatch, insufficient work planning, and risk management, mixed safety leadership, workforce negative attributes, lapsed safety enforcement and resources shortages collectively give rise to the project sub-optimum safety performance. From the dynamic causation and multilevel perspective, the analyses show that the individual, group, and organizational levels issues are interrelated and these interrelationships are linked to negative safety climate. Hence the adoption of both perspectives has enabled a fuller understanding of the phenomenon of safety management that point to the need for an organizational-systemic intervention strategy. The core message points to the fact that intervention at an individual level will only meet with limited success if the risks embedded in the higher levels in group and project organization are not addressed. The findings can be used to guide the effective development of safety infrastructure by linking different levels of systems in a construction project organization.

Keywords: construction safety management, dynamic causation, multilevel analysis, safety climate

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Authors: M. D. Haneef, R. B. Randall, Z. Peng

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Journal bearings used in IC engines are prone to premature failures and are likely to fail earlier than the rated life due to highly impulsive and unstable operating conditions and frequent starts/stops. Vibration signature extraction and wear debris analysis techniques are prevalent in the industry for condition monitoring of rotary machinery. However, both techniques involve a great deal of technical expertise, time and cost. Limited literature is available on the application of these techniques for fault detection in reciprocating machinery, due to the complex nature of impact forces that confounds the extraction of fault signals for vibration based analysis and wear prediction. This work is an extension of a previous study, in which an engine simulation model was developed using a MATLAB/SIMULINK program, whereby the engine parameters used in the simulation were obtained experimentally from a Toyota 3SFE 2.0 litre petrol engines. Simulated hydrodynamic bearing forces were used to estimate vibrations signals and envelope analysis was carried out to analyze the effect of speed, load and clearance on the vibration response. Three different loads 50/80/110 N-m, three different speeds 1500/2000/3000 rpm, and three different clearances, i.e., normal, 2 times and 4 times the normal clearance were simulated to examine the effect of wear on bearing forces. The magnitude of the squared envelope of the generated vibration signals though not affected by load, but was observed to rise significantly with increasing speed and clearance indicating the likelihood of augmented wear. In the present study, the simulation model was extended further to investigate the bearing wear behavior, resulting as a consequence of different operating conditions, to complement the vibration analysis. In the current simulation, the dynamics of the engine was established first, based on which the hydrodynamic journal bearing forces were evaluated by numerical solution of the Reynold’s equation. Also, the essential outputs of interest in this study, critical to determine wear rates are the tangential velocity and oil film thickness between the journal and bearing sleeve, which if not maintained appropriately, have a detrimental effect on the bearing performance. Archard’s wear prediction model was used in the simulation to calculate the wear rate of bearings with specific location information as all determinative parameters were obtained with reference to crank rotation. Oil film thickness obtained from the model was used as a criterion to determine if the lubrication is sufficient to prevent contact between the journal and bearing thus causing accelerated wear. A limiting value of 1 µm was used as the minimum oil film thickness needed to prevent contact. The increased wear rate with growing severity of operating conditions is analogous and comparable to the rise in amplitude of the squared envelope of the referenced vibration signals. Thus on one hand, the developed model demonstrated its capability to explain wear behavior and on the other hand it also helps to establish a correlation between wear based and vibration based analysis. Therefore, the model provides a cost-effective and quick approach to predict the impending wear in IC engine bearings under various operating conditions.

Keywords: condition monitoring, IC engine, journal bearings, vibration analysis, wear prediction

Procedia PDF Downloads 300

Authors: Domenica Bona

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Colin Chant and David Goodman argue that historians of Chinese pre-industrial cities tend to underestimate revolutions and overestimate cyclic patterns: periods of peace and prosperity in the earl part of each d nast , followed b peasants’ rebellions and upheavals. Boyd described these cyclic patterns as part of the background of Chinese town planning and architecture. Thus old ideals of city planning-square plan, southward orientation and a palace along the central axis - are revived again and again in the ascendant phases of several d nastic c cles (e.g. Chang’an, Kaifen, and Beijing). Along this line of thought, m paper questions the relationship between the “magic square rule” and modern Chinese urban- planning. As a matter of fact, the classical theme of “cosmic Taoist urbanism” is still a reference for planning cities and new urban developments, whenever there is the intention to express nationalist ideals and “cultural straightforwardness.” Besides, some case studies can be related to “modern d nasties”: the first Republic under the Kuo Min Tang, the red People’s Republic and the post-Maoist open country of Deng Xiao Ping. Considering the project for the new capital of Nanjing in the Thirties, Beijing’s Tianan Men area in the ifties, and Shenzhen’s utian CBD in late 20th century, I argue that cyclic patterns are still in place, though with deformations related to westernization, private interests and lack of spirituality. How far new Chinese cities are - or simply seem to be - westernized? Symbolism, invisible frameworks, repeating features and behavioural patterns make urban China just “superficiall” western. This can be well noticed in cities previousl occupied b foreigners, like Hong Kong, or in newly founded ones, like Shenzhen, where both Asians and non-Asian people can feel the gender-shift from New-York-like landscapes to something else. Current planning in main metropolitan areas shows a blurred relationship between public policies and private investments: two levels of decisions and actions, one addressing the larger scale and infrastructures, the other concerning the micro scale and development of single plots. While zoning is instrumental in this process, master plans are often laid out over a very poor cartography, so much that any relation between the formal characters of new cities and the centuries-old structure of the related territory gets lost.

Keywords: China, contemporary cities, cultural heritage, shenzhen, urban planning

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Authors: Ciaran Friel, Jerry Suls, Patrick Robles, Frank Vicari, Joan Duer-Hefele, Karina W. Davidson

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Physical activity guidelines focus on increasing moderate intensity activity for older adults, but adherence to recommendations remains low. This is despite the fact that scientific evidence supports that any increase in physical activity is positively correlated with health benefits. Behavior change techniques (BCTs) have demonstrated effectiveness in reducing sedentary behavior and promoting physical activity. This pilot study uses a Personalized Trials (N-of-1) design to evaluate the efficacy of using four BCTs to promote an increase in low-intensity physical activity (2,000 steps of walking per day) in adults aged 45-75 years old. The 4 BCTs tested were goal setting, action planning, feedback, and self-monitoring. BCTs were tested in random order and delivered by text message prompts requiring participant response. The study recruited health system employees in the target age range, without mobility restrictions and demonstrating interest in increasing their daily activity by a minimum of 2,000 steps per day for a minimum of five days per week. Participants were sent a Fitbit Charge 4 fitness tracker with an established study account and password. Participants were recommended to wear the Fitbit device 24/7, but were required to wear it for a minimum of ten hours per day. Baseline physical activity was measured by the Fitbit for two weeks. Participants then engaged with a clinical research coordinator to review comprehension of the text message content and required actions for each of the BCTs to be tested. Participants then selected a consistent daily time in which they would receive their text message prompt. In the 8 week intervention phase of the study, participants received each of the four BCTs, in random order, for a two week period. Text message prompts were delivered daily at a time selected by the participant. All prompts required an interactive response from participants and may have included recording their detailed plan for walking or daily step goal (action planning, goal setting). Additionally, participants may have been directed to a study dashboard to view their step counts or compare themselves with peers (self-monitoring, feedback). At the end of each two week testing interval, participants were asked to complete the Self-Efficacy for Walking Scale (SEW_Dur), a validated measure that assesses the participant’s confidence in walking incremental distances and a survey measuring their satisfaction with the individual BCT that they tested. At the end of their trial, participants received a personalized summary of their step data in response to each individual BCT. Analysis will examine the novel individual-level heterogeneity of treatment effect made possible by N-of-1 design, and pool results across participants to efficiently estimate the overall efficacy of the selected behavioral change techniques in increasing low-intensity walking by 2,000 steps, 5 days per week. Self-efficacy will be explored as the likely mechanism of action prompting behavior change. This study will inform the providers and demonstrate the feasibility of N-of-1 study design to effectively promote physical activity as a component of healthy aging.

Keywords: aging, exercise, habit, walking

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Authors: Xiaoqing Peng, Aijing Luo, Yang Chen

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Background: Cyberchondria, as an "emerging risk" accompanied by the information era, is a new abnormal pattern characterized by excessive or repeated online searches for health-related information and escalating health anxiety, which endangers people's physical and mental health and poses a huge threat to public health. Objective: To explore and discuss the research status, hotspots and trends of Cyberchondria. Methods: Based on a total of 77 articles regarding "Cyberchondria" extracted from Web of Science from the beginning till October 2019, the literature trends, countries, institutions, hotspots are analyzed by bibliometric analysis, the concept definition of Cyberchondria, instruments, relevant factors, treatment and intervention are discussed as well. Results: Since "Cyberchondria" was put forward for the first time in 2001, the last two decades witnessed a noticeable increase in the amount of literature, especially during 2014-2019, it quadrupled dramatically at 62 compared with that before 2014 only at 15, which shows that Cyberchondria has become a new theme and hot topic in recent years. The United States was the most active contributor with the largest publication (23), followed by England (11) and Australia (11), while the leading institutions were Baylor University(7) and University of Sydney(7), followed by Florida State University(4) and University of Manchester(4). The WoS categories "Psychiatry/Psychology " and "Computer/ Information Science "were the areas of greatest influence. The concept definition of Cyberchondria is not completely unified in the world, but it is generally considered as an abnormal behavioral pattern and emotional state and has been invoked to refer to the anxiety-amplifying effects of online health-related searches. The first and the most frequently cited scale for measuring the severity of Cyberchondria called “The Cyberchondria Severity Scale (CSS) ”was developed in 2014, which conceptualized Cyberchondria as a multidimensional construct consisting of compulsion, distress, excessiveness, reassurance, and mistrust of medical professionals which was proved to be not necessary for this construct later. Since then, the Brazilian, German, Turkish, Polish and Chinese versions were subsequently developed, improved and culturally adjusted, while CSS was optimized to a simplified version (CSS-12) in 2019, all of which should be worthy of further verification. The hotspots of Cyberchondria mainly focuses on relevant factors as follows: intolerance of uncertainty, anxiety sensitivity, obsessive-compulsive disorder, internet addition, abnormal illness behavior, Whiteley index, problematic internet use, trying to make clear the role played by “associated factors” and “anxiety-amplifying factors” in the development of Cyberchondria, to better understand the aetiological links and pathways in the relationships between hypochondriasis, health anxiety and online health-related searches. Although the treatment and intervention of Cyberchondria are still in the initial stage of exploration, there are kinds of meaningful attempts to seek effective strategies from different aspects such as online psychological treatment, network technology management, health information literacy improvement and public health service. Conclusion: Research on Cyberchondria is in its infancy but should be deserved more attention. A conceptual consensus on Cyberchondria, a refined assessment tool, prospective studies conducted in various populations, targeted treatments for it would be the main research direction in the near future.

Keywords: cyberchondria, hypochondriasis, health anxiety, online health-related searches

Procedia PDF Downloads 110

Authors: Teodorica G. Ani

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Economic activity requires an encouraging regulatory environment and effective rules that are transparent and accessible to all. The World Bank has been publishing the annual Doing Business reports since 2004 to investigate the scope and manner of regulations that enhance business activity and those that constrain it. A streamlined business environment supporting the development of competitive small and medium enterprises (SMEs) may expand employment opportunities and improve the living conditions of low income households. Asia has emerged as one of the most attractive markets in the world. Economies in East Asia and the Pacific were among the most active in making it easier for local firms to do business. The study aimed to describe the ease of doing business and its effect to economic growth among selected economies in Asia for the year 2014. The study covered 29 economies in East Asia, Southeast Asia, South Asia and Middle Asia. Ease of doing business is measured by the Doing Business indicators (DBI) of the World Bank. The indicators cover ten aspects of the ease of doing business such as starting a business, dealing with construction permits, getting electricity, registering property, getting credit, protecting investors, paying taxes, trading across borders, enforcing contracts and resolving insolvency. In the study, Gross Domestic Product (GDP) was used as the proxy variable for economic growth. Descriptive research was the research design used. Graphical analysis was used to describe the income and doing business among selected economies. In addition, multiple regression was used to determine the effect of doing business to economic growth. The study presented the income among selected economies. The graph showed China has the highest income while Maldives produces the lowest and that observation were supported by gathered literatures. The study also presented the status of the ten indicators of doing business among selected economies. The graphs showed varying trends on how easy to start a business, deal with construction permits and to register property. Starting a business is easiest in Singapore followed by Hong Kong. The study found out that the variations in ease of doing business is explained by starting a business, dealing with construction permits and registering property. Moreover, an explanation of the regression result implies that a day increase in the average number of days it takes to complete a procedure will decrease the value of GDP in general. The research proposed inputs to policy which may increase the awareness of local government units of different economies on the simplification of the policies of the different components used in measuring doing business.

Keywords: doing business, economic growth, gross domestic product, Asia

Procedia PDF Downloads 367

Authors: Wing Mui Winnie So, Tian Luo, Zeyu Han

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To fully explore and develop the potentials of gifted students systematically and strategically by providing them with opportunities to receive education at appropriate levels, schools in Hong Kong are encouraged to adopt the "Three-Tier Implementation Model" to plan and implement the school-based gifted education, with Level Three refers to the provision of learning opportunities for the exceptionally gifted students in the form of specialist training outside the school setting by post-secondary institutions, non-government organisations, professional bodies and technology enterprises. Due to the growing concern worldwide about low interest among students in pursuing STEM (Science, Technology, Engineering, and Mathematics) careers, cultivating and boosting STEM career interest has been an emerging research focus worldwide. Although numerous studies have explored its critical contributors, little research has examined the effectiveness of comprehensive interventions such as “Studying with STEM professional”. This study aims to examine the effect on gifted students’ career interest during their participation in an off-school support programme designed and supervised by a team of STEM educators and STEM professionals from a university. Gifted students were provided opportunities and tasks to experience STEM career topics that are not included in the school syllabus, and to experience how to think and work like a STEM professional in their learning. Participants involved 40 primary school students joining the intervention programme outside the normal school setting. Research methods included adopting the STEM career interest survey and drawing tasks supplemented with writing before and after the programme, as well as interviews before the end of the programme. The semi-structured interviews focused on students’ views regarding STEM professionals; what’s it like to learn with a STEM professional; what’s it like to work and think like a STEM professional; and students’ STEM identity and career interest. The changes in gifted students’ STEM career interest and its well-recognised significant contributors, for example, STEM stereotypes, self-efficacy for STEM activities, and STEM outcome expectation, were collectively examined from the pre- and post-survey using T-test. Thematic analysis was conducted for the interview records to explore how studying with STEM professional intervention can help students understand STEM careers; build STEM identity; as well as how to think and work like a STEM professional. Results indicated a significant difference in STEM career interest before and after the intervention. The influencing mechanism was also identified from the measurement of the related contributors and the analysis of drawings and interviews. The potential of off-school support programme supervised by STEM educators and professionals to develop gifted students’ STEM career interest is argued to be further unleashed in future research and practice.

Keywords: gifted students, STEM career, STEM education, STEM professionals

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Authors: Kar Yue Chan

Abstract:

Cantonese opera is a valuable heritage originated from South China, and started to span its influence across the area to Hong Kong, and became extremely popular back in the 1950s to the 1970s. It has also been honoured and recognized as one treasurable item on the Intangible Cultural Heritage of Humanity on the Representative List of UNESCO since 2009. A certain level of difficulty is encountered when one identifies the gender roles and representations from a usual performance of Cantonese opera, as conventional practices of Cantonese opera display to the audience that many of the male hero roles are played by female upon the prior knowledge of all audience, and it is understandable for them as well because in the past there were insufficient male actors and performers on the market. Female actresses, in some senses, are more capable to sing near-male voices, and their appearances in heroic operatic attires are more appreciated by general audience. Therefore, perspectives of 'feminine representation' and the 'Reception Theory' in literature are conducive to analyzing such phenomenon. In spite of some 'normal' performances with romantic love stories or historical accounts involving often a talented intellectual and a beautiful wise lady (in Chinese caizi jiaren 才子佳人), in which the male role is actually male and the female role is actually female, there have still been some opera titles specifically manifesting these extreme gender associations by putting together displacement of gender roles in the same performance in view of such chaotic complication. On top of all other factors, translators dealing with any operatic texts face plenty of challenges upon transferring Cantonese operatic performances into English. It is found that translators need to deal with cultural elements embedded in the lyrics; the form (which is as delicate as those deriving from classical Chinese poetry); the gender misplacements that affect the mood and tone of the lyrics that much when they are in the process of translating. Some lyrics and tunes are specifically designed for a particular gender role to perform, while some others are more generic; both of which require different and specific translation strategies. After scrutinizing the various sources of reference, readers of this paper should be well informed of a significance which lies in the refined nature of the poetic form and content that signifies in the way the distinguished gender voice segregation of the discourse from which the lyrics are derived, and definitely also through the on-stage performability aspect of the task. In order to produce a relatively short and concise translated version which fits performance needs, all of the above factors will be looked at in this paper with relevant examples and analysis.

Keywords: Cantonese opera, translation, chaotic gender, performance

Procedia PDF Downloads 115